Ultra-early neurologic outcome prediction of out-of-hospital cardiac arrest survivors using combined diffusion-weighted imaging findings and quantitative analysis of apparent diffusion coefficient

Park, Jung Soo; In, Yong; You, Yeon Ho; Min, Jin Hong; Ahn, Hong Joon; Yoo, In Sool; Kim, Seung Whan; Lee, Jin Woong; Ryu, Seung Ho; Jeong, Won Joon; Cho, Yong Chul; Oh, Se Kwang; Cho, Sung Uk; Kang, Changshin; Lee, Byung Kook; Lee, Dong Hun; Lee, Dong Hoon

doi:10.1016/j.resuscitation.2019.12.021

Cited by 26 publications

(41 citation statements)

References 36 publications

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“…When CytE occurs, ADC values are lowered because of the parallel shrinkage of the neuronal cell bodies. A decrease in ADC values may serve as an indication that the affected areas of the brain will die [17]. The severity of CytE represented by lowered ADC values can be measured quantitatively [10,17].…”

Section: Discussionmentioning

confidence: 99%

Does Combining Biomarkers and Brain Images Provide Improved Prognostic Predictive Performance for Out-Of-Hospital Cardiac Arrest Survivors before Target Temperature Management?

Son

Park

Yoo

et al. 2020

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We examined whether combining biomarkers measurements and brain images early after the return of spontaneous circulation improves prognostic performance compared with the use of either biomarkers or brain images for patients with cardiac arrest following target temperature management (TTM). This retrospective observational study involved comatose out-of-hospital cardiac arrest survivors. We analyzed neuron-specific enolase levels in serum (NSE) or cerebrospinal fluid (CSF), grey-to-white matter ratio by brain computed tomography, presence of high signal intensity (HSI) in diffusion-weighted imaging (DWI), and voxel-based apparent diffusion coefficient (ADC). Of the 58 patients, 33 (56.9%) had poor neurologic outcomes. CSF NSE levels showed better prognostic performance (area under the curve (AUC) 0.873, 95% confidence interval (CI) 0.749–0.950) than serum NSE levels (AUC 0.792, 95% CI 0.644–0.888). HSI in DWI showed the best prognostic performance (AUC 0.833, 95% CI 0.711–0.919). Combining CSF NSE levels and HSI in DWI had better prognostic performance (AUC 0.925, 95% CI 0.813–0.981) than each individual method, followed by the combination of serum NSE levels and HSI on DWI and that of CSF NSE levels and the percentage of voxels of ADC (AUC 0.901, 95% CI 0.792–0.965; AUC 0.849, 95% CI 0.717–0.935, respectively). Combining CSF/serum NSE levels and HSI in DWI before TTM improved the prognostic performance compared to either each individual method or other combinations.

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Section: Discussionmentioning

confidence: 99%

Does Combining Biomarkers and Brain Images Provide Improved Prognostic Predictive Performance for Out-Of-Hospital Cardiac Arrest Survivors before Target Temperature Management?

Son

Park

Yoo

et al. 2020

JCM

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“…However, in other studies [78,115], MRI was performed at a median of 3 h after ROSC. In a study not included in our review [168] changes on DWI MRI predicted poor neurological outcome within 6 h from ROSC. The time at which brain CT and MRI are performed may depend on clinical and organisational issues rather than on their accuracy.…”

Section: Study Limitationsmentioning

confidence: 97%

Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review

et al. 2020

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Purpose: To assess the ability of clinical examination, blood biomarkers, electrophysiology, or neuroimaging assessed within 7 days from return of spontaneous circulation (ROSC) to predict poor neurological outcome, defined as death, vegetative state, or severe disability (CPC 3-5) at hospital discharge/1 month or later, in comatose adult survivors from cardiac arrest (CA). Methods: PubMed, EMBASE, Web of Science, and the Cochrane Database of Systematic Reviews (January 2013-April 2020) were searched. Sensitivity and false-positive rate (FPR) for each predictor were calculated. Due to heterogeneities in recording times, predictor thresholds, and definition of some predictors, meta-analysis was not performed. Results: Ninety-four studies (30,200 patients) were included. Bilaterally absent pupillary or corneal reflexes after day 4 from ROSC, high blood values of neuron-specific enolase from 24 h after ROSC, absent N20 waves of short-latency somatosensory-evoked potentials (SSEPs) or unequivocal seizures on electroencephalogram (EEG) from the day of ROSC, EEG background suppression or burst-suppression from 24 h after ROSC, diffuse cerebral oedema on brain CT from 2 h after ROSC, or reduced diffusion on brain MRI at 2-5 days after ROSC had 0% FPR for poor outcome in most studies. Risk of bias assessed using the QUIPS tool was high for all predictors. Conclusion: In comatose resuscitated patients, clinical, biochemical, neurophysiological, and radiological tests have a potential to predict poor neurological outcome with no false-positive predictions within the first week after CA. Guidelines should consider the methodological concerns and limited sensitivity for individual modalities. (PROSPERO CRD42019141169

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“…Brain DWI was performed using a 3T scanner (Achieva, Philips Healthcare, Amsterdam, The Netherlands) before TTM. The imaging protocol and analysis used were the same as those published previously [ 14 , 15 , 16 ]. Previous studies used the percentage of voxels (PV) below different ADC thresholds and reported that PV 400 (percentage of voxels <400 × 10 −6 mm 2 /s) showed the highest odds ratio value when predicting the poor prognosis of a patient [ 14 ]; therefore, we also used PV 400.…”

Section: Methodsmentioning

confidence: 99%

Using Out-of-Hospital Cardiac Arrest (OHCA) and Cardiac Arrest Hospital Prognosis (CAHP) Scores with Modified Objective Data to Improve Neurological Prognostic Performance for Out-of-Hospital Cardiac Arrest Survivors

Song

Park

You

et al. 2021

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This study aimed to determine whether accuracy and sensitivity concerning neurological prognostic performance increased for survivors of out-of-hospital cardiac arrest (OHCA) treated with targeted temperature management (TTM), using OHCA and cardiac arrest hospital prognosis (CAHP) scores and modified objective variables. We retrospectively analyzed non-traumatic OHCA survivors treated with TTM. The primary outcome was poor neurological outcome at 3 months after return of spontaneous circulation (cerebral performance category, 3–5). We compared neurological prognostic performance using existing models after adding objective data obtained before TTM from computed tomography (CT), magnetic resonance imaging (MRI), and biomarkers to replace the no-flow time component of the OHCA and CAHP models. Among 106 patients, 61 (57.5%) had poor neurologic outcomes. The area under the receiver operating characteristic (AUROC) curve for the OHCA and CAHP models was 0.89 (95% confidence interval (CI) 0.81–0.94) and 0.90 (95% CI 0.82–0.95), respectively. The prediction of poor neurological outcome improved after replacing no-flow time with a grey/white matter ratio measured using CT, high-signal intensity (HSI) on diffusion-weighted MRI (DWI), percentage of voxel using apparent diffusion coefficient value, and serum neuron-specific enolase levels. When replaced with HSI on DWI, the AUROC and sensitivity of the OHCA and CAHP models were 0.96 and 74.5% and 0.97 and 83.8%, respectively (100% specificity). Prognoses concerning neurologic outcomes improved compared with existing OHCA and CAHP models by adding new objective variables to replace no-flow time. External validation is required to generalize these results in various contexts.

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Ultra-early neurologic outcome prediction of out-of-hospital cardiac arrest survivors using combined diffusion-weighted imaging findings and quantitative analysis of apparent diffusion coefficient

Cited by 26 publications

References 36 publications

Does Combining Biomarkers and Brain Images Provide Improved Prognostic Predictive Performance for Out-Of-Hospital Cardiac Arrest Survivors before Target Temperature Management?

Does Combining Biomarkers and Brain Images Provide Improved Prognostic Predictive Performance for Out-Of-Hospital Cardiac Arrest Survivors before Target Temperature Management?

Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review

Using Out-of-Hospital Cardiac Arrest (OHCA) and Cardiac Arrest Hospital Prognosis (CAHP) Scores with Modified Objective Data to Improve Neurological Prognostic Performance for Out-of-Hospital Cardiac Arrest Survivors

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